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Multicenter Study
. 2025 Sep 1;31(9):2438-2450.
doi: 10.1093/ibd/izaf023.

Small Bowel Motility Quantified by Cine MRI to Predict Longer-Term Response in Patients with Crohn's Disease Commencing Biological Therapy: The Motility Study

Andrew A Plumb  1   2 , Gordon Moran  3 , Kashfia Chowdhury  4 , Norin Ahmed  4 , Sue Philpott  4 , Tariq Ahmad  5 , Stuart Bloom  6 , Ailsa Hart  7 , Ilan Jacobs  8 , Alex Menys  9 , Peter Mooney  10 , Damian Tolan  11 , Simon Travis  12 , Anisha Bhagwanani  13 , Gauraang Bhatnagar  9   13 , Darren Boone  1   2 , James Franklin  14 , Anmol Gangi-Burton  15 , Maira Hameed  1   2 , Emma Helbren  16 , Faraz Hosseini-Ardehali  1 , Rachel Hyland  11 , Yakup Kilic  1 , Shankar Kumar  1   2 , Hannah Lambie  11 , Maryam Mohsin  11 , Anisha Patel  17 , Safi Rahman  11 , Naomi Sakai  1   2 , Harbir Sidhu  1   2 , Elen Thomson  11 , Saiam Ahmed  4 , Uday Bannur Chikkeragowda  15 , Nina Barratt  18 , Teresita Beeston  1   2 , Heather Fitzke  2 , Nicola Gibbons  19 , Edmund Godfrey  20 , Arun Gupta  21 , Antony Higginson  19 , Elizabeth Isaac  1   2 , Klaartje Bel Kok  22 , Sarah Langlands  23 , Miles Parkes  24 , Jaymin Patel  25 , Kamal Patel  25 , Kamini Patel  26 , Nishant Patodi  27 , Richard Pollok  28 , Robert Przemiosolo  29 , Charlotte Robinson  30 , Nora Thoua  31 , Anvi Wadke  4 , Steve Halligan  2 , Stuart A Taylor  2 ; MOTILITY study co-authors
Collaborators, Affiliations
Multicenter Study

Small Bowel Motility Quantified by Cine MRI to Predict Longer-Term Response in Patients with Crohn's Disease Commencing Biological Therapy: The Motility Study

Andrew A Plumb et al. Inflamm Bowel Dis. .

Abstract

Background: Small bowel Crohn's disease (SBCD) is increasingly treated with biological therapies. Predicting response or remission (RoR) for individual patients is difficult and complicates treatment strategy. We aimed to determine if motility magnetic resonance imaging (mMRI) is superior to CRP and fecal calprotectin (FC) for the prediction of RoR at 1 year in patients commencing biologics for SBCD.

Methods: Prospective, multicenter (n = 13) cohort study of patients with active non-stricturing SBCD requiring anti-TNFα or anti-IL-12/23 treatment. We measured mMRI and CRP at baseline and post-induction (visit 2: 12-30 weeks), and FC in a subset. RoR was assessed at 1 year using clinical and structural magnetic resonance enterography parameters. We compared sensitivity, specificity, and area under the receiver operating characteristic curve (ROC-AUC) of changes in mMRI and CRP to predict RoR at 1 year. Secondary outcomes compared mMRI with FC, and prediction of improved quality of life (QoL).

Results: Eighty-six participants completed all assessments. Stable or improved mMRI at visit 2 was more sensitive than normalization of CRP for RoR (mMRI:71.0%, 95%CI 52.0-85.8; CRP:45.2%, 95%CI 27.3-64.0%, P = .008) but less specific (mMRI:30.9%, 95%CI 19.1-44.8; CRP:67.3%, 95%CI 53.3-79.3%, P < .001). There was no significant difference in ROC-AUC (mMRI:0.48; CRP:0.53, P = .65). Similar results were obtained for FC. None of mMRI, CRP, or FC predicted patient QoL at 1 year.

Conclusions: Although improved mMRI is more sensitive than CRP and FC to predict RoR at 1 year, it is less specific. No factor predicted patient QoL. Motility MRI remains a marker of disease activity at given timepoints.

Keywords: Crohn’s disease; biologics (IBD); inflammatory bowel disease; radiology/imaging; small intestine.

Plain language summary

Changes in CRP, fecal calprotectin level, or small bowel motility as quantified by MRI do not reliably predict response or remission to biological therapy at 1 year. Motility MRI is a useful marker of active small bowel inflammation.

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Conflict of interest statement

G.M. has served as a speaker, a consultant, and/or an advisory board member for Abbvie, Alimentiv, Pfizer, and Satisfai Health and has received research funding from AstraZeneca, Bristol Myers Squib, Jansen, and Pfizer. T.A. has served as a speaker, a consultant, and/or an advisory board member for Amgen, Celltrion, Eli Lilly, and Janssen; and has received research funding from AbbVie, Biogen, Celgene, F Hoffmann-La Roche, Galapagos, Hospira (Pfizer), MSD, Napp Pharmaceuticals, Nova Pharmaceuticals, Takeda, and Pfizer. A.H. has served as a speaker, a consultant, and/or an advisory board member for Abbvie, Bristol Myers Squib, Celltrion, Galapagos, Johnson & Johnson, Lilly, Pfizer, Roche, and Takeda. A.M. is an employee of Motilent and owns stocks and shares in Motilent. P.M. has served as a speaker, a consultant, and/or an advisory board member for Takeda. S.T. has served as a speaker, a consultant and/or an advisory board member for Abbvie, Apexian, Bioclinica, Bristol Myers Squib, ChemoCentryx, Cosmo, Endpoint Health, Enterome, Equilium, Ferring, GSK, Genentech, Immunocore, Immunometabolism, Janssen, Lilly, Mestag, Novartis, Pfizer, Protagonist, Roche, Sanofi, Satisfai Health, Sensyne, Spyre, Sun Pharma, Takeda, TR1X, UCB, VHSquare, Vifor, and Violicom; has received research funding from Abbvie, IOIBD, Lilly, UCB, Vifor, Norman Collisson Foundation, Pfizer, UKIERI, ECCO, Helmsley Trust and GSK; and owns stocks and shares in Satisfai Health Inc. G.B. has served as a speaker, a consultant, and/or an advisory board member for Alimentiv; is an employee of Motilent; owns stocks and shares in Motilent; and owns patent in P295276.US.02, system to characterize topology and morphology of fistulae from medical imaging data. E.G. has served as a speaker, a consultant, and/or an advisory board member for Bayer and Olympus. K.B.K. has served as a speaker, a consultant, and/or an advisory board member for Abbvie, Falk, Galapagos, Janssen, and Takeda. M.P. has served as a speaker, a consultant, and/or an advisory board member for Janssen and Takeda; and has received research funding from AstraZeneca, Galapagos, Gilead, and Pfizer. J.P. is an employee of Hexarad and owns stocks and shares in Hexarad. K.P. has served as a speaker, a consultant and/or and advisory board member for Abbvie, Alfasigma, Celltrion, DrFalk, Ferring, Galapagos, Janssen, PreddictImmune, Pfizer, Takeda, and Tillotts; and has received research funding from Abbvie. C.R. has served as a consultant for Perspectum. S.H. has served as an advisory board member for the National Screening Committee multicancer detection, adult reference and AI task groups, and the HTA Prioritization Board. S.T. has served as a speaker, a consultant, and an advisory board member for AstraZeneca, has received research funding from Takeda, and owns stocks and shares in Motilent. All other authors report no personal interests.

Figures

Figure 1.
Figure 1.
Assessment of disease response or remission for participants who had not met clinical criteria for non-response. *SES-CD = simple endoscopic score for Crohn’s disease; MRE score = magnetic resonance enterography London Score (see Table S1 for details of calculation). Clinical criteria for non-response were any of: (1) requirement for enteric surgery for small bowel disease, (2) need to change or stop biological therapy because of loss of efficacy, or (3) requirement for steroid rescue for active luminal Crohn’s disease.
Figure 2.
Figure 2.
Procedure for mMRI ROI placement. Top left panel shows a segment of terminal ileum (green crescent-shaped region of interest) and its corresponding motility score of 0.07 in the top right panel (labeled GIQuant = 114.6). Radiologist readers were provided with mMRI scans from each visit and were instructed to draw a single ROI on an affected segment of bowel at each visit. Radiologists were instructed to ensure similar size and configuration of ROIs between visits; as shown in this example (bottom left panel). In this example, the GIQuant score at follow-up had increased to 207.5.
Figure 3.
Figure 3.
Study flowchart.
Figure 4.
Figure 4.
Receiver operating characteristic curve and area under the curve for percentage change in mMRI and change in CRP from baseline to visit 2 for response or remission (RoR) at 1 year.
Figure 5.
Figure 5.
Receiver operating characteristic and area under the curve for percentage change in mMRI and change in fecal calprotectin from baseline to visit 2 for response or remission (RoR) at 1 year.
See this image and copyright information in PMC

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